Global Burden of Cancer

For many years, global health has been associated with diseases like HIV/AIDS and malaria. And rightly so. These diseases present significant threats to health around the world. But they aren't the only major killers. In fact, they're not even the leading killers anymore! Today, cancer claims more lives globally than HIV/AIDS, malaria, and tuberculosis combined, and the death toll from cancer is only going to grow.

Cancer is a major burden of disease worldwide. Each year, tens of millions of people are diagnosed with cancer around the world, and more than half of the patients eventually die from it. In many countries, cancer ranks the second most common cause of death following cardiovascular diseases.

5 Ways to Spot and Stop Smoking-Related Cancers

At 70 years old, Lydia Whitlow likes to stay active. “I like to work in the yard. It feels good to turn the soil and watch my garden grow,” she says.

Enjoying a sun-filled day in south Houston seemed nearly impossible a few years before, given the circumstances.

Fifteen years ago, her dentist discovered oral cancer during a routine exam. After aggressive surgery, Whitlow, a smoker for nearly 50 years, was relieved to find out she was in remission.

In 2006, she received the grim news she would be fighting cancer for a second round. This time it would be one of the deadliest forms of the disease. An ache in her back led to the diagnosis of “small cell” lung cancer, usually caused from smoking. Small cell is aggressive. Once diagnosed, most patients with metastatic small cell cancer have a poor survival rate.

Other physicians she consulted told her the inoperable cancer in her lungs was resisting traditional therapies. She was out of options, they said.

Whitlow, however, isn’t “most patients,” thanks to lifesaving research at the Center for Thermal Therapy Cancer Treatment at The University of Texas Medical School at Houston. That’s where Joan Bull, MD, professor of oncology, told Whitlow there was hope.

For six months, Whitlow climbed into a heavy-duty sleeping bag and warmed by heat lamps. She was then warmed to 104 degrees Fahrenheit, equivalent to a high fever. Preliminary research has shown that heat increases the effectiveness of chemotherapy drugs in fighting tumors. The heat jumpstarts the immune system just like a normal fever does when we are sick, says Bull. “Evidence shows that the combination of chemotherapy, immune-modulating drugs and thermal therapy helps weaken the cancer and, in Whitlow’s case, kills it altogether. In other cases, it can help reduce a tumor to an operable size,” she explains.

Bull is now in Phase 2 of her clinical trials. Her research on thermal therapy is published in the Dec. 2008 issue of the International Journal of Hyperthermia.

Whitlow received thermal therapy treatments once a month. She was lightly sedated during each six-hour treatment session and warmed up by an infrared radiant heat device. “I would be really tired at the end of those sessions. You feel a little weak, but otherwise OK,” she says.

Bull says Whitlow responded to the treatment beautifully. She is now disease free.

Bull can treat patients with small-cell lung, non-small-cell, neuroendocrine and pancreatic cancers. She also works with patients who have breast, endometrial and cervical cancers.

Dentists, like Whitlow’s, serve an important role in the fight against smoking-related cancers. Last year, the American Dental Association (ADA) launched a three-year nationwide public service campaign to boost public awareness of oral cancer and showcase a dentist’s role in helping spot the disease early.

“We educate and train our students to become skillful at obtaining a comprehensive medical history, including family and social history and risk-factor assessment from their patients. We stress the importance of asking the questions, probing deeper into high risk behaviors and actively listening for both verbal and nonverbal cues. We also train them on how to perform a thorough head and neck examination on all their patients to detect early signs and symptoms of cancer,” says Catherine M. Flaitz, DDS, oral and maxillofacial pathologist and dean of the UT Dental Branch at Houston.

“The professors teach us how to identify ‘red flag’ conditions, not just in the mouth, but in the entire head and neck area,” says Nicholas Camarata, a third-year student at the Dental Branch. “It is important for us as students to learn as much as we can about the clinical presentations of oral cancer, so that we are able to practice identifying what is a variation of normal and what should be looked at in greater detail.”

The warning signs include:

• white or red spots on the lips, gum tissue, tongue, roof of the mouth or inside the cheeks
• a sore that bleeds easily or does not heal
• pain, tenderness or numbness anywhere in the mouth or on the lips
• difficulty chewing, swallowing, speaking or moving the jaw or tongue
• a color change in the mouth
• and a change in “occlusion”-the way the teeth fit together.

Flaitz adds that in today’s dental practices, dentists may supplement a clinical examination with new oral cancer detection devices that enhance the visualization of a suspicious lesion for both the patient and the health care provider. Once a suspicious area has been identified, a surgical biopsy is required to make a diagnosis and determine the extent of the disease. Although general dentists may perform these procedures, most patients are referred to oral and maxillofacial surgeons for the biopsy, if a cancer is the primary concern. This tissue is then sent to either a general pathology or oral and maxillofacial surgical pathology laboratory for processing and evaluation.

If you spot oral cancer in an early stage, there is a near 95 percent survival rate. Unfortunately, most oral cancers go undetected until they become clinically obvious and have spread. Since early detection is key to saving lives and facial disfigurement, research is focused on identifying special biomarkers in the lining of the mouth and in saliva that signal a problem before a lesion is apparent. In addition, progress continues in developing advanced light sources that can detect oral cancer before the eye can see it.

Flaitz adds that this is no longer a disease of older individuals. The fastest growing group is patients under 40 who don’t have any classic symptoms or risk factors.

If you use tobacco, there’s one way to lessen your chances of becoming a cancer statistic: quit. But, no one says it’s easy. For the more than 45 million Americans who use tobacco¬, research shows nicotine can be as addictive as cocaine. Most smokers will make at least 11 attempts before they successfully quit.

“Smoking is a very tough public health issue. The key is prevention,” warns Kathleen Reeve, DrPH, associate professor at the UT School of Nursing and a published author on this topic. “We need to do a better job of reaching out to adolescents.” A school curriculum program called ASPIRE (A Smoking Prevention Interactive Experience), jointly developed by The UT School of Public Health and The University of Texas M. D. Anderson Cancer Center, is helping get the word out to teenagers.

“The program offers interactive activities, videos, support strategies and fun animations to help teenagers make their own choices and stay on the path of good health. It can even offer guidance to adolescents who want to quit,” says Nancy Murray, PhD, assistant professor of health promotion and behavioral sciences at the School of Public Health.

According to a study this year in the journal of Nicotine and Tobacco Research, ASPIRE was proven to be effective in smoking prevention and cessation among teenagers.

Reeve also says that it helps to know that your body is on your side. For instance: Your body will begin to experience relief just 20 minutes after you stop smoking:

• Twenty minutes after quitting: Your heart rate and blood pressure drops.
• Twelve hours after quitting: The carbon monoxide level in your blood drops to normal.
• Two weeks to three months after quitting: Your circulation improves and your lung function increases.
• One to nine months after quitting: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function, increasing the ability to handle mucus, clean the lungs and reduce the risk of infection.
• Five to 15 years after quitting: Your stroke risk is reduced to that of a nonsmoker.
• Ten years after quitting: The lung cancer death rate is about half that of a continuing smoker’s. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decreases.
• Fifteen years after quitting: The risk of coronary heart disease is that of a nonsmoker’s.

Professor Joy Schmitz, PhD, in the Department of Psychiatry and Behavioral Sciences at the medical school, is a leading expert on smoking cessation. Schmitz says pharmaceuticals are proven to be highly effective.

“The nicotine gum and nicotine patch are two types of replacement therapies. Other types include the nicotine nasal spray, inhaler and lozenge. They all share the same pharmacologic rationale: to aid cessation efforts by providing the smoker with a safer, non-addictive delivery of nicotine and thereby reduce nicotine withdrawal symptoms,” says Schmitz.

Newer, FDA-approved, non-nicotine medications include bupropion (Zyban) and varenicline (Chantix).
Bupropion is the anti-depressant drug also known as Wellbutrin. It has been shown to reduce significantly nicotine withdrawal symptoms, although how it works is not fully understood, says Schmitz.

Varenicline has been shown to reduce cravings for cigarettes and also decrease the pleasurable effects of smoking. “All of these medication options have been tested in randomized clinical trials and have been shown to more than double the odds of quitting when compared to a placebo,” says Schmitz.

Smoking not only impacts the person choosing to continue the habit, but also those around them. Secondhand smoke is classified as a “known human carcinogen” by the U.S. Environmental Protection Agency, the U.S. National Toxicology Program and the International Agency for Research on Cancer, a branch of World Health Organization.

A 2006 U.S. Surgeon General’s Report showed:
• Secondhand smoke causes premature death and disease in children and adults who do not smoke.
• Babies exposed to secondhand smoke are at an increased risk of sudden infant death syndrome (SIDS), acute respiratory infections, ear infections and more severe asthma.
• Secondhand smoke immediately affects the heart and blood circulation in a harmful way.
• Exposure over a long time period can cause heart disease and lung cancer.

A current study at the medical school is researching how secondhand smoke impacts some of the most vulnerable babies. Researchers are recruiting parents who have an infant in the neonatal intensive care unit (NICU) at Children’s Memorial Hermann Hospital who have at least one smoker in their household, says Angela Stotts, PhD, associate professor of family medicine at the medical school.

“The study consists of motivational interventions before the infant leaves the NICU. We talk with the family and address concerns the infant could experience from secondhand smoke. We also counsel them on what they can do to reduce their child’s exposure to the smoke. One novel aspect is that we are traveling to the infant’s home at one, three and six months after they go home to leave monitors which measure nicotine levels,” explains Stotts.

In a nationwide effort to help people kick the habit, the American Cancer Society holds its annual Great American Smoke Out during November.

The goal of the campaign is to rally local volunteers to help support smokers who want to quit and press for laws that control tobacco use.

Looking back, Whitlow counts her blessings. “They told me I was one of the lucky ones. I do feel lucky; others simply don’t make it.” That’s why she is doing all she can to spare others her hard-earned lessons.. “Whenever I see young people smoking, I simply go up to them and begin chatting. I tell them it is bad, and then share my story. I regret picking up my first cigarette when I was 18. If I could go back, I would.”

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